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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------ -------------------------------- Permit No. - -------I-------I------------------- (Complete in Triplicate) ----------------- ______________________ This Permit Expires 1 Year From Date Issued Hate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N - '- -1 e = _ -------CENSUS TRACT ---------------------•---- Owner's Name .... _ .ev_fi�_____/�`�.4r%____ ! E------------------------------------- - -------------------Phone ----------------------�•-----•-•---- Address ---- -----------33oe2,7------�Ft 1 -------------------------- City ` ----------------------------------------- Contractor's -----------------------------------.Contractor's Name .-------,---_- - ------------------------------License # Phone ------------- Installation will.serve: Residence Apartment House'❑ Commercial❑Trailer Court ;E]M tel ❑Other --- ---------=--------------- Number of living units:------t Number of bedrooms t�_____Garbage Grinder --- Lot Size ___________________________________________ Water Supply: Public System and name .____ .4_ -__1IV ___ ..._ _______________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ `Peat❑' Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe ' Fill Material J�R__ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ ) SEPTIC TANK iv Size____ __X_ C__S_____ ____._____._____ Liquid Depth .__Y--Z -------------- Capacity r . p Y � �..€9'�---- Type - --- -- - ---- Material�y.cn.c - No. Compa4rtments ....2".................. Distance to nearest: Well ------------ ------------------Foundation ......J__0 Prop.•Line -S'_/............. LEACHING LINE J/y No. of Lines -----A_:--------------- -Length-of each line __1............ Total Length ,�_Q. .f______________ 'D' Box ._A>_0___ Type Filter Material Depth Filter Material _______#_ _______________________________ Distance to nearest: Well ------ Foundation ./0-/-------------- Property Line /� afi--.._-.__._•___ SEEPAGE PIT []�}` Depth -_Q-�_1----- Diameter 3C__`..------ Number _____._._ _� _______3 Rock Filled Yes No ❑ Water Table Depth -------Crf-O--r-------------------------------Rock Size ---- -J�-----��----=------- / Distance to nearest: Well ____.__' _ �________________Foundation --- --------- Prop. Line _�S_.L__..__..._.._. t� REPAIR/ADDITION{Prey. Sanitation Permit=# -------------------------------------------- Date --------.----------.--------------1 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------------------------------------------•--- Disposal Field (Specify Requirements) ----_.---__ _______________________________________ -------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ----------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Siate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------I--------- - - Owner -- --- - ---- ) BY --------------- ------ -- ( -- - --- --------- ------------------------ Title ------ n ? ------------------------------ (if of r h owner) ) FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY ------- --------------------------------' ---------------------------------- DATE ---,2-" - -�'y-------- --- BUILDING PERMIT .ISSUED _.__ - ------DATE ---- --------•------ --- ADDITIONAL COMMENTS ._ .l Q = _ 2•--?--2_ ""..�'"°� -- ------ ------------------------------------------------------------------------------------------------------------------------------ ------------- - --- - ------------ ----- -- - ---------- ------ - - - - -------- ------- --- - Final Inspection b Date - _.`z-- ....7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C-